19 April 201019 April 2010

Surgical anatomy through the Surgical anatomy through the agesages

Surgical anatomy through the Surgical anatomy through the agesages

Dr Sanjoy SanyalDr Sanjoy SanyalConsultant surgeon and ProfessorConsultant surgeon and Professor

Medical University of Americas, Nevis Medical University of Americas, Nevis St. Kitts-Nevis, W.I.St. Kitts-Nevis, W.I.

sanyal.sanjoy8@gmail.comsanyal.sanjoy8@gmail.com

Introductory presentation for 1st year medical students

ContentsContents Timeline: Walking down the centuriesTimeline: Walking down the centuries

GreeceGreeceItalyItalyEnglandEnglandModernModern

Interesting historical highlightsInteresting historical highlightsReligious restrictions to dissectionsReligious restrictions to dissectionsSocio-legal implications of restrictionsSocio-legal implications of restrictions

Early anatomical depictionsEarly anatomical depictions Modern anatomy depictionsModern anatomy depictions Concluding famous quotesConcluding famous quotes

TimelineTimeline

Oldest known medical scienceOldest known medical scienceAncient (early) anatomyAncient (early) anatomy: 16: 16thth century century

BCE to 2BCE to 2ndnd century AD (Greece; ended century AD (Greece; ended with Galen)with Galen)

Early (medieval) anatomyEarly (medieval) anatomy: 14: 14thth to 16 to 16thth century (Started in Italy)century (Started in Italy)

1717thth-18-18thth century anatomy century anatomy (Italy) (Italy)1818thth-19-19thth century anatomy century anatomy (England) (England)Modern anatomyModern anatomy: Last 100 years: Last 100 years

Timeline cont’dTimeline cont’dGreeksGreeks

Alcmaeon and EmpodoclesAlcmaeon and EmpodoclesHippocratesHippocrates: Father of Medicine: Father of MedicineAristotleAristotleHerophilus / Erasistratus: Herophilus / Erasistratus:

11stst human dissection human dissectionGalenGalen: Dissected monkeys : Dissected monkeys

Considered Father of Ancient AnatomyConsidered Father of Ancient AnatomyHis publication was equivalent of ‘Gray's His publication was equivalent of ‘Gray's

Anatomy’ of ancient world for 1500 yearsAnatomy’ of ancient world for 1500 years

Timeline cont’dTimeline cont’dNot much progress after fall of Roman Empire; Not much progress after fall of Roman Empire;

Marked the hiatus between 2Marked the hiatus between 2ndnd to 14 to 14thth century AD century AD ItalyItaly: Centre of Anatomy (Bologna, Padua): Centre of Anatomy (Bologna, Padua)

Mondino de Liuzzi, Alessandro AchilliniMondino de Liuzzi, Alessandro AchilliniAndreas VesaliusAndreas Vesalius: Dissected human bodies : Dissected human bodies

and disproved many of Galen’s work because and disproved many of Galen’s work because they were animal models; Considered as they were animal models; Considered as Father of Modern AnatomyFather of Modern AnatomyM. Realdo ColomboM. Realdo ColomboGabriele FalloppioGabriele Falloppio

Giovanni Filippo IngrassiasGiovanni Filippo Ingrassias

Students

Fabrica Fabrica title page title page Andreae Vesalii Andreae Vesalii

Bruxellensis, scholae Bruxellensis, scholae medicorum Patauinae medicorum Patauinae professoris, de Humani professoris, de Humani corporis fabrica Libri corporis fabrica Libri septem septem

((Andreas Vesalius of Andreas Vesalius of Brussels, professor at Brussels, professor at the school of medicine the school of medicine at Padua, on the fabric at Padua, on the fabric of the Human body in of the Human body in seven Booksseven Books))

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Vesalius’ workVesalius’ workThe The FabricaFabrica is known for is known for

its highly detailed its highly detailed illustrations of allegorical illustrations of allegorical human dissectionshuman dissections

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Aris KindtAris Kindt (Aris the (Aris the Kid), a.k.a. Kid), a.k.a. Adriaan Adriaan Adriaanszoon, Adriaanszoon, was convicted of was convicted of armed robbery in armed robbery in the Netherlands in the Netherlands in early 1600s. He early 1600s. He was sentenced to was sentenced to death by hanging death by hanging

His body was His body was autopsied by autopsied by Amsterdam Guild of Amsterdam Guild of Surgeons on 16 Surgeons on 16 January 1632January 1632

Autopsy was captured in Autopsy was captured in 1632 by Rembrandt in his 1632 by Rembrandt in his painting, painting, Anatomy Lesson of Anatomy Lesson of Dr. Nicolaes TulpDr. Nicolaes Tulp, which , which depicts surgeon Nicolaes depicts surgeon Nicolaes Tulp at workTulp at work

Early craniotomyEarly craniotomy

Timeline cont’dTimeline cont’dEnglandEngland (19 (19thth century) century)

Descriptive Human Anatomy of previous Descriptive Human Anatomy of previous centurycentury finalised / systematisedfinalised / systematised

Histology and Developmental BiologyHistology and Developmental BiologyGray’s AnatomyGray’s Anatomy: Henry Gray compiled a : Henry Gray compiled a

single volume for ‘traveling’ doctorsingle volume for ‘traveling’ doctor

Timeline cont’dTimeline cont’dAmerica and elsewhereAmerica and elsewhere (Last 100 years) (Last 100 years)

Evolutionary and Molecular BiologyEvolutionary and Molecular Biology EndocrinologyEndocrinology GeneticsGeneticsRadiological anatomy: X-ray, CT scan, MRI, Radiological anatomy: X-ray, CT scan, MRI,

PET scan PET scan VisibleVisible Human Project (National Library of Human Project (National Library of

Medicine)Medicine)Photographic, computerized, 3-D, digital, Photographic, computerized, 3-D, digital,

animated depictionsanimated depictions

Early historical highlightsEarly historical highlights

(Against operating on humans and (Against operating on humans and handling, and dissecting human cadavers)handling, and dissecting human cadavers)

Italy: Religious taboosItaly: Religious taboos

England: Socio-legal implicationsEngland: Socio-legal implications

Religious restrictionsReligious restrictions Italian Church abhorred spilling of blood Italian Church abhorred spilling of blood Only gallows victims were allowed to be Only gallows victims were allowed to be

dissecteddissectedOnly in Italy (Padua, Bologna) could dissections Only in Italy (Padua, Bologna) could dissections

be performed; Vesalius dissected in Paduabe performed; Vesalius dissected in PaduaOnly in Italy could female cadavers be Only in Italy could female cadavers be

dissecteddissectedOnly certified / Royal anatomists could perform Only certified / Royal anatomists could perform

dissections; for 1-year termdissections; for 1-year termCity councilors sponsored dissections – City councilors sponsored dissections –

charged admission feecharged admission feeAttending dissections was legalAttending dissections was legal

Religious restrictionsReligious restrictionsReprimandReprimandPersecutionPersecution ImprisonmentImprisonmentHouse arrestHouse arrestBanning publicationBanning publicationBurning publicationsBurning publicationsDeath sentenceDeath sentenceGalileo Galilie and Rene Galileo Galilie and Rene

Descartes were 2 such Descartes were 2 such victims of church persecutionvictims of church persecution

Rene Descartes

Galileo Galilie

Socio-legal scenarioSocio-legal scenarioBarbersBarbers: Only were permitted to perform minor : Only were permitted to perform minor

surgeries (lancing abscess, removing corn etc)surgeries (lancing abscess, removing corn etc)

SurgeonsSurgeons: But they needed to acquire skills : But they needed to acquire skills and learn the human bodyand learn the human body

AnatomistsAnatomists: But human cadavers were difficult : But human cadavers were difficult to come byto come by

Body-snatchers

Grave robbers

Thieves

Murderers

Gave rise to

Gave rise to

Took the help of

Criminal gangs

Socio-legal scenarioSocio-legal scenarioReluctance of society to donate one's self for Reluctance of society to donate one's self for

betterment of medical sciencebetterment of medical scienceWilliam HarveyWilliam Harvey, discoverer of circulation of , discoverer of circulation of

blood, dissected both his father and his sister blood, dissected both his father and his sister The bodies were not donated for dissection with The bodies were not donated for dissection with

altruistic motives altruistic motives They were attained by force, theft, body-They were attained by force, theft, body-

snatching, grave-robbery, even murdersnatching, grave-robbery, even murderPeople do not wish to associate with that kind People do not wish to associate with that kind

of history; Hence laws were enacted of history; Hence laws were enacted

Legal implicationsLegal implications 1752 — England’s Murder Act1752 — England’s Murder Act 1824 — Unclaimed bodies to be used for 1824 — Unclaimed bodies to be used for

dissectiondissection 1825-26 — "Great Inflation": grave robbers 1825-26 — "Great Inflation": grave robbers

charged higher prices for corpsescharged higher prices for corpses 1832 — Anatomy Act: allowed use of 1832 — Anatomy Act: allowed use of

unclaimed pauper bodies from hospital for unclaimed pauper bodies from hospital for sale and dissectionsale and dissection

1834 — Poor Law Amendment Act1834 — Poor Law Amendment Act TODAY TODAY — All bodies for dissection in — All bodies for dissection in

teaching institutions are by donationsteaching institutions are by donations

Modern cadaver dissection tableModern cadaver dissection table

Autopsy dissection in progressAutopsy dissection in progress

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WoodcutWoodcut

Wood engravingWood engraving

Hand coloringHand coloring

Metal etching with acidMetal etching with acid

Metal mezzotintMetal mezzotint

CopperplateCopperplate

LithographyLithography

Modern anatomical depictionsModern anatomical depictions

Color drawings / diagrams, Color drawings / diagrams, Photographic demonstrationPhotographic demonstrationSynthetic modelsSynthetic modelsRadiological depictionsRadiological depictionsDigital radiographyDigital radiography3-D digital reconstruction3-D digital reconstructionAnimated depictionsAnimated depictions

Th

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Th

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Th

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Th

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An old depiction of thoracic cage (left) vs. a modern depiction of same (right)

Photography

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Skeleton – student demonstrationSkeleton – student demonstration

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““Science Science knows no knows no country, country, because because knowledge knowledge belongs to belongs to humanity, humanity, and is the and is the torch torch which which illuminates illuminates the world.”the world.”

--Louis --Louis PasteurPasteur

"Don't be afraid to "Don't be afraid to take a big step. You take a big step. You can't cross a chasm can't cross a chasm in two small jumps."in two small jumps."

--David Lloyd George--David Lloyd George

"You've made it this far. Keep going a little longer and you'll see the sun rise on a "You've made it this far. Keep going a little longer and you'll see the sun rise on a beautiful new day." beautiful new day." --Ralph Marston--Ralph Marston